Graham H. Jeffries

Immunologic Distinction between Infectious and Serum Hepatitis

Abstract Serums from patients with acute viral hepatitis were tested for the presence of the serum-hepatitis (SH) antigen to determine whether this would permit distinction between the two major types of viral hepatitis. None of four patients with short-incubation MS-1 infection (Willowbrook) had detectable antigen, whereas this antigen was identified in all eight cases of long-incubation MS-2 infection (Willowbrook). Correspondingly, only one out of 74 cases associated with four epidemics of infectious hepatitis, and none of 19 sporadic cases occurring in children under the age of 14 showed presence of detectable antigen, whereas 76 of 116 cases (66 per cent) that followed exposure to contaminated needles and 25 of 43 post-transfusion cases (58 per cent) were positive. SH antigen was also detected in 71 of 129 patients (55 per cent) with viral hepatitis who gave no history of parenteral exposure. Serum-hepatitis virus thus appears to be the major cause of sporadic hepatitis in urban adults regardless of ...

The effect of prednisolone on gastric mucosal histology, gastric secretion, and vitamin B 12 absorption in patients with pernicious anemia.

The effect of corticosteroids on the gastric mucosa in patients with pernicious anemia is of particular interest in view of the possibility that atrophic gastritis, the primary pathologic lesion in pernicious anemia, may result from destruction of gastric glands by an autoimmune process (1). The first observation which suggested that corticosteroids might enhance vitamin B12 absorption in patients with pernicious anemia was made by Doig, Girdwood, Duthie, and Knox (2). Three of four patients treated with prednisolone exhibited a hematologic response with a reticulocytosis, an increase in hemoglobin and red blood cell count, and correction of the megaloblastic to normoblastic erythropoiesis. In several studies that were stimulated by this observation, it was suggested alternatively that prednisolone enhanced vitamin B12 absorption in the absence of intrinsic factor (3) and that prednisolone stimulated the gastric secretion of intrinsic factor in these patients (4, 5). Kristensen and Friis (6) proved that the latter mechanism was responsible for the increase in vitamin B12 absorption during corticosteroid therapy. They found that gastric juice collected from pernicious anemia patients with enhanced vitamin B12 absorption during therapy with prednisolone contained intrinsic factor on in vivo assay.

Chronic ulcerative (nongranulomatous) jejunitis

Abstract Four patients suffering from chronic ulcerative (nongranulomatous) Jejunitis are described. Severe diarrhea with abdominal pain and fever, steatorrhea and hypoproteinemia due to enteric loss of plasma protein were the predominant clinical features. Peroral biopsies of the jejunal mucosa revealed villous atrophy in three patients but the characteristic pathologic abnormality in surgical biopsy specimens of the jejunum and in the small intestine examined at postmortem was the presence of multiple mucosal ulcers with adjacent areas of both atrophic and normal mucosa. Treatment with a gluten-free diet was ineffective, whereas corticosteroid therapy, although unpredictable in its effect, appeared to be of benefit to several patients. The differential diagnosis of this condition is discussed.

Hypertrophic, hypersecretory protein-losing gastropathy.

Summary A patient who presented with the clinical manifestations of hypoproteinemia and in whom gastric hyperrugosity was associated with excessive gastric protein loss and acid hypersecretion is reported. Atropine sulfate markedly reduced both the hypersecretion and gastric protein loss. It is suggested that anticholinergic therapy be considered in any patient with a protein-losing gastropathy of nonmalignant etiology in whom high, normal, and perhaps even subnormal acid secretion is found following maximal histamine stimulation.

Recurrent cholestatic jaundice of pregnancy with demonstrated estrogen sensitivity

Abstract Described herein is a patient with cholestatic jaundice which recurred during each of eight (or nine) pregnancies. Similar episodes of jaundice were associated with abnormal menses (menorrhagia). Following delivery or with the onset of menstruation the patient became asymptomatic, and liver function returned to normal. Liver biopsies showed intrahepatic cholestasis during pregnancy, and a return to normal after pregnancy. An identical clinical picture with jaundice and abnormal liver function tests was induced when the patient was challenged with the synthetic estrogen, estinyl estradiol (1 mg. daily). This patient is presented as a case of idiopathic recurrent cholestatic jaundice of pregnancy. The evidence that this entity may have a hormonal basis is discussed.

Recovery of Gastric Mucosal Structure and Function in Pernicious Anemia During Prednisolone Therapy

Summary A patient with pernicious anemia was treated with prednisolone, 20 mg daily, for 4 months. During this therapy, there was a return of acid and intrinsic factor secretion, normal vitamin B 12 absorption, and a regeneration of gastric mucosal glands containing abundant chief and parietal cells. Although there was a decrease in the titer of intrinsic factor antibody in the patients serum, there was no change in the titer of parietal cell antibodies. This steroid effect is consistent with the hypothesis that gastric mucosal atrophy in pernicious anemia is due to autoimmune destruction of the gastric glands, and that prolonged suppression of these immunologic processes may lead to mucosal regeneration with acid and intrinsic factor secretion.

Effects of Ethinylestradiol-Induced Cholestasis on Bile Flow and Biliary Excretion of Estradiol and Estradiol Glucuronide by the Rat∗

Summary The effects of ethinylestradiol treatment on bile flow and biliary excretion of bromsulfophthalein, estradiol, and estradiol glucuronide in the rat were studied. One day following 9 days of 0.5 mg of ethinylestradiol treatment, bile duct cannulation and femoral vein catheterization were carried out. From that time until the end of study, bile flow was strikingly reduced in the estrogen-treated animals to less than 50% of that in the control group. One day following surgery, studies of biliary excretion were performed revealing a markedly diminished biliary excretion of radioactivity from intravenously administered tracer doses of both estradiol and estradiol glucuronide in the treated animals. The effect of estrogen treatment on bile flow and estrogen excretion in the bile is similar to that previously observed for bromsulfophthalein clearance. Possible mechanisms of estrogen action and implications in human estrogen-induced cholestasis are discussed.

Elevated Prostaglandin E in Idiopathic Intestinal Pseudo-Obstruction

The syndrome of idiopathic intestinal pseudoobstruction, described by Naish et al. in 1960,1 consists of repeated bouts of idiopathic intestinal pseudo-obstruction accompanied by diarrhea and at ti...

Portal Hypertension with Bleeding Vaginal Varices

Excerpt Abnormal vascular communications between the portal and systemic vascular systems may be present in fibrous adhesions joining the visceral and parietal peritoneum after abdominal or pelvic ...

THE PHARMACOLOGY OF INTRINSIC FACTOR SECRETION IN MAN.

Summary An in vitro technique based on the interaction between intrinsic factor and intrinsic factor antibody, was used to measure gastric intrinsic factor secretion following histamine, betazole hydrochloride, and methacholine stimulation in man. The secretion of intrinsic factor was augmented by each of these gastric secretory stimuli. The maximal secretion of intrinsic factor was observed during the first 15 min of stimulation and preceded the maximal secretion of acid and water.